The Lazarus effect: Team tracks down homeless people in need of mental health medication

Angela Piper, left on bench, shows her identification to Adrian Mesa, psychiatric advance registered nurse practitioner, kneeling, as Lazarus Project team members, Lazaro Trueba, Ivan Romero, and Claudia Basso, right, canvas the streets of downtown Miami to administer psychiatric, social, and heath treatments for their Miami's chronic homelessness clients on Tuesday, June 7, 2015. For more than six months, a team of four has headed out into the streets of downtown Miami area to serve medical and psychiatric treatments to the chronic homelessness clients.
CARL JUSTE
Miami Herald Staff

It’s just after 8 a.m., and Lazaro Trueba and Ivan Romero are driving around downtown with a pack of Clipper cigars and a stash of psychotropic pills in search of “Bigfoot.”

At around 6-foot-6, he’s hard to miss. But after two decades living on the streets and struggling with mental illness, Jesse, the man they’ve lovingly nicknamed after the mythical Sasquatch, has a penchant for both walking long distances and disappearing. And finding him is important, because like their other clients he needs his medication.

Every morning, the two Miami homeless-outreach workers tour downtown in a white Ford Econoline along with a psychiatric nurse practitioner from Camillus Health. They go out in search of a small group of men and women who are among the most isolated and desperate of Miami’s homeless population, in order to earn their trust, diagnose their condition and then hand them their medication and watch them take it.

The program is entirely voluntary. But without the drugs — which take weeks of daily use before quelling symptoms of mental illness — they will likely continue to bounce between the streets, psychiatric wards, hospital beds and jail cells. By tracking them down every day to give them their pills, Trueba’s crew has shown they can draw some of Miami’s most vulnerable from out of the shadows and back into the light.

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“These are people who have been out here 20 and 25 years,” says Trueba, a senior administrator and 20-year veteran of Miami’s homeless assistance program. “And nobody has been able to help them.”

By flipping the script and bringing the clinic to them, Miami’s homeless outreach, Camillus Health, and the Miami Coalition for the Homeless are trying to change that.

On an April morning, with Bigfoot nowhere to be found, Trueba, 54, turns the van around and heads back toward downtown, where he finds Alec Johnson sitting on the steps of a Miami Dade College building.

Trueba has known Johnson for more than a decade, and he never before accepted assistance or an offer for a shelter bed. When they first began working with him, he was in rough shape, disheveled anddisinterested in talking. On this morning, though, he’s had a haircut and a recent change of clothes. He takes two mini cigars, some food, and gives Claudia Basso, a Lazarus Project case manager, permission to file paperwork to seek Social Security and food stamps on his behalf from the government.

Next up is Mildred, an affable but rail-thin woman with rubber bracelets pulled up past her elbows. Sometimes when they find her, she has a crack pipe in her hand, but today the 84-year-old has just had an encounter with a Miami police officer.

They ask her if she wants to get a place to stay, and as she usually does she claims she already has an apartment. They push, and then she says no.

“I don’t want to smell the walls,” she says.

The going is slow, and progress isn’t guaranteed. But Trueba knows from experience that his plan will work.

Twenty years ago, when he first began working as an outreach worker, Trueba noticed that many who left Jackson Memorial Hospital’s crisis ward with anti-psychotic medication after being committed under Florida’s Baker Act would fail to take their pills and wind up right back in the hospital after breaking down again.

So, with the help of a doctor, he and a partner quietly began holding on to the patients’ medication and finding them every day in order to give them their pills. Unwittingly, he had stumbled onto a type of treatment called direct observation therapy, associated more with tuberculosis treatment. But he was taking a significant risk.

“We had a lot of success, but we weren’t licensed [to practice medicine],” he said. “We kind of did this on the down-low.”

The effort didn’t last. Trueba moved into administration, and his partner left.

But last year, Trueba shared his story with Bobbie Ibarra, executive director of the Miami Coalition for the Homeless.

Ibarra liked the idea and reached out to Camillus House CEO Shed Boren, who also runs Camillus Health, a federally qualified health center allowed to practice healthcare on the streets. Boren didn’t have any extra funding for the work, but he was on board and dubbed the effort the Lazarus Project, a nod to both Trueba and the Biblical figure whom Christ resurrected.

With Trueba and Romero’s guidance, Camillus Health medical practitioners and the Coalition selected nine men and women and obtained their medical histories and diagnosis. Beginning in the fall, they went out every morning for a month, without medication, in order to get to know their candidates and give them the choice to opt into the program.

It was a steep challenge. The anticipated cost was close to $300,000, and according to the Coalition the first Lazarus Project clients had more than 200 arrests on record between them. But seven people signed up.

One of their first clients was Leon Davis, a soft-spoken 26-year-old from Savannah whose life fell apart about six years ago when he began hearing voices inside his head. He bounced around, ended up in a Tallahassee shelter, then caught a one-way bus ticket to Miami on a whim about two years ago.

The Lazarus Project team found him living out of a suitcase beneath the Flagler Street bridge in an area he swept clean every day with a broom. At first, he was stand-offish. But over time he began taking medication, and then agreed to stay in a shelter bed. On Thanksgiving, Camillus Health practitioner Adrian Mesa invited him to dinner with his family, and Davis met Mesa’s uncle, who runs a construction company.

Since December, Davis has earned $100 a day working at the Grove Station construction site off Southwest 27th Avenue.He now lives in Somerville, a subsidized Camillus House apartment.

“I lost it all,” Davis said. “Now, I’m very spiritual, my spiritual life is a lot bigger. I write a lot. I do a lot of music. It changed for the better.”

Other clients have had different levels of success through the program. Bigfoot — who is among several patients whose full identities Camillus Health will not reveal due to doctor-client privilege and privacy concerns — is being placed in an assisted living facility by case workers at Jackson Memorial Hospital. Another client nicknamed Triple-J, who thought he was a rap star when the team met him in Bayfront Park, has received medication and returned home to his family in Pahokee.

Luz, a Peruvian woman who used to wear a nun’s habit made of garbage bags and walk around with napkins taped to her swollen feet, has moved into Camillus House’s Norwegian Cruise Lines campus after 10 years on the streets. She now receives disability checks, and was able to afford a leather outfit to replace the garbage bags.

Alec Johnson is now receiving food stamps, and talks with Trueba and Romero when they come to see him every morning. Recently, he spent a couple of nights at a Camillus House shelter.

Mesa gave the Herald a list of clients and their outcomes, showing that after almost a year of work most their patients are receiving some kind of treatment, have moved into a shelter or are awaiting benefits and placement. Amongst them, they’d been hospitalized hundreds of times and arrested dozens more before the Lazarus Project began, but few, if any, have been in a cell or hospital bed since.

Miami-Dade Judge Steve Leifman, an expert on mental illness and advocate for Miami-Dade’s population, can’t recall anyone ever doing direct observation treatment for Miami’s homeless. He believes programs like the Lazarus Project offer great hope for reaching those who have been deemed hopeless.

“After doing this for so many years you come to an understanding that there are just people who have an illness and the system has been really abusive to them for decades. And it really discourages people from receiving the treatment that they need,” he said. “We need to do more of this, to have better outreach, to have a warmer, friendlier treatment system that encourages people to want to get help. This is a great step.”

But nothing is easy, and not everyone shows results. There are new faces downtown every day, and while the number of homeless on the streets has been significantly reduced over the last few decades, the chronic homeless who remain are among the hardest to reach.

Some mornings bring the team over to the James L. Knight Center, where a towering man named Mike “Mango” often sits in a municipal parking lot. On a May morning, they hand him a bag of snacks and two Clipper cigars and he lays out the ingredients on the sidewalk. His hair is matted and his clothes are caked with dirt. Two weeks later, he’s in the same clothes, surrounded by energy drinks and a bottle of water in which he’s mixed coffee grinds. They ask him if he has slept recently, and he prattles off something about time travel.

Last week, they find him walking down the street. He stops and takes a cocktail of aqua and white pills, a dosage that continues to increase in potency with minimal results, and tells them “Thanks for the drugs!” before almost skipping off.

Mesa, who in an email noted that most Lazarus Project clients have no history of drug abuse, says “these programs will never bring in huge numbers.” But he says the point is to go find the people who won’t come into a clinic, and intervene before they have a crisis and end up in jail or in a hospital.

“If you’re going to work in an outreach center, then you need to do outreach,” he says.

For Camillus Health, the cost of the program has been considerable. But Boren, the CEO, wants to continue and expand the effort. He’s now seeking a grant from the Miami-Dade Homeless Trust to pick up the cost of the program and hopefully create additional outreach teams.

“We currently do this a few hours a day — and we are seeing results,” he said. “My idea is to get a few full-time teams on this effort and see if we can really make a difference.”

About this story:

On four occasions, the Miami Herald tailed the Lazarus Project team on their runs around downtown Miami. Due to concerns about healthcare privacy and consent, Camillus House withheld medical information about some patients, and the Herald agreed to not publish their full names or use their images.